Provider Demographics
NPI:1881980704
Name:PACHECO, KEVIN (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1725
Mailing Address - Country:US
Mailing Address - Phone:214-400-7527
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO ADRIATICO
Practice Address - Street 2:BOULEVARD DENT
Practice Address - City:SAN PEDRO
Practice Address - State:SAN JOSE
Practice Address - Zip Code:11501
Practice Address - Country:CR
Practice Address - Phone:506-719-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13342208D00000X
NY275486208D00000X
TXT7323208D00000X
TXT7327208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice